An Unusual Case of Portal Hypertension Secondary to Primary Hypoplasia of the Portal Vein

2017 ◽  
Vol 53 (6) ◽  
pp. 331-337
Author(s):  
Lauren Harris ◽  
Miryam Reems ◽  
Sharon Dial
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Clinical Manifestations ◽  
Normal Liver ◽  
Normal Serum ◽  
Serum Bile Acid ◽  
Liver Histopathology ◽  
Portosystemic Shunts ◽  
Portosystemic Collateral ◽  
Portal Hypoperfusion

ABSTRACT Primary hypoplasia of the portal vein with secondary portal hypertension and acquired portosystemic collateral circulation is infrequently reported in the veterinary literature. Diagnosis of this condition requires documentation of abnormal hepatocellular function, the lack of intrahepatic or extrahepatic macroscopic congenital portosystemic shunts, and liver histopathology demonstrating portal hypoperfusion in the absence of hepatic inflammation or nodular regeneration. Due to a perceived poor prognosis, many patients with this condition are euthanized; however, those that are spared can be medically managed, in some cases for years. This case report describes the diagnosis and management of a patient with primary hypoplasia of the portal vein and secondary portal hypertension that presented with the severe but typical clinical manifestations of ascites and hepatic encephalopathy, normal liver enzyme concentrations, and normal serum bile acid concentrations.

scholarly journals Primary portal vein hypoplasia with portal hypertension in a young dog

2017 ◽  
Vol 65 (4) ◽  
pp. 257
Author(s):  
D. KASABALIS (Δ. ΚΑΣΑΜΠΑΛΗΣ) ◽  
D. ALATZAS (Δ. ΑΛΑΤΖΑΣ) ◽  
D. ALATZA (Δ. ΑΛΑΤΖΑ) ◽  
T. A. PETANIDES (Θ. ΠΕΤΑΝΙΔΗΣ) ◽  
G. ALATZAS (Γ. ΑΛΑΤΖΑΣ) ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Exploratory Laparotomy ◽  
Abdominal Ultrasonography ◽  
Liver Histopathology ◽  
Low Protein ◽  
Portosystemic Collateral ◽  
History Of ◽  
Collateral Vessels

A 5-month old Caucasian dog was presented with a 20-day history of abdominal distention along with inappetance, depression and vomiting of 24-hour duration. Physical examination findings included depression, ascites, mild inspiratory dyspnea and dehydration. Clinicopathological evaluation revealed hyperammonemia, hypoalbuminemia, hyperbilirubinemia, hypoglycemia and hyponatremia. Μicrohepatia and free abdominal fluid was detected with abdominal ultrasonography. During exploratory laparotomy, multiple acquired portosystemic collateral vessels were found, indicative of portal hypertension, along with a small liver of normal color and texture. Liver histopathology included features consistent with liver hypoperfusion. These findings supported the diagnosis of primary portal vein hypoplasia with portal hypertension. The animal recovered uneventfully postoperatively and was discharged with diuretics, hepatoprotectants and a low-protein diet and remains healthy two years after diagnosis. This case underscores that a favorable prognosis may be anticipated in cases of primary portal vein hypoplasia with portal hypertension, thus, justifying the long-term conservative management instead of considering euthanasia.

The Etiology of Portal Hypertension in Egyptian Children and Adolescents

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Lerine B El-Din Ahmed ◽  
Asmaa W Abd Elaziz ◽  
Reham I Abdelmegeed ◽  
Mayada Abd El-Rahman F Battah
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Pressure Gradient ◽  
Portal Vein Thrombosis ◽  
Hepatic Fibrosis ◽  
Venous Pressure ◽  
Vena Cava ◽  
Clinical Manifestations ◽  
Vein Thrombosis ◽  
Egyptian Children

Abstract Background Portal hypertension is a clinical syndrome in which the portal venous pressure gradient between portal vein and inferior vena cava exceeding 5mmHg. Clinically significant portal hypertension is diagnosed when clinical manifestations of the disease appear or the portal pressure gradient exceeding 10 mmHg. For better management, it is important to determine the underlying cause. Objective To evaluate the aetiology of portal hypertension in pediatric who attending the hepatology clinic at El-Demerdash hospital, Ain Shams University. Materials and Methods This cross sectional study was done in the department of pediatric hepatology clinic at El-Demerdash hospital, Ain Shams University on 91 consecutive cases of portal hypertension enrolled from 2016 to 2019. All pediatric patients were subjected to full history, clinical examination, investigations and questionnaire about effect of portal hypertension and its complications on QOL. Results Age of children and adolescent was 5 months to 16 years with mean age of 5.55±4.30y and male to female ration was 1.5:1. Out of 91 children (51, 56.1%) developed portal hypertension due to extrahepatic causes and (39, 42.9%) due to hepatic causes. In extrahepatic causes (portal vein thrombosis was found 36, (39.6%) and Budd Chiari syndrome 15(16.5%)). On the other hand, hepatic causes (cong. hepatic fibrosis (CHF) was found in 21(23.1%), cases, hepatic cirrhosis 12(13.2%), extrahepatic biliary atresia 3(3.3%) and autoimmune hepatitis with secondary hepatic fibrosis 3(3.3%)). In extrahepatic cases first variant bleed much earlier than hepatic cases. Conclusion Extrahepatic disease were the most common aetiology of portal hypertension in studied cases. Portal vein thrombosis in extrahepatic cases and congenital hepatic fibrosis in intrahepatic cases were the most common causes.

scholarly journals Extrahepatic Portal Vein Thrombosis, an Important Cause of Portal Hypertension in Children

2021 ◽  
Vol 10 (12) ◽  
pp. 2703
Author(s):  
Alina Grama ◽  
Alexandru Pîrvan ◽  
Claudia Sîrbe ◽  
Lucia Burac ◽  
Horia Ştefănescu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Bacterial Infections ◽  
Umbilical Vein ◽  
Clinical Manifestations ◽  
Vein Thrombosis ◽  
Vein Catheterization

One of the most important causes of portal hypertension among children is extrahepatic portal vein thrombosis (EHPVT). The most common risk factors for EHPVT are neonatal umbilical vein catheterization, transfusions, bacterial infections, dehydration, and thrombophilia. Our study aimed to describe the clinical manifestations, treatment, evolution, and risk factors of children with EHPVT. Methods: We analyzed retrospectively all children admitted and followed in our hospital with EHPVT between January 2011–December 2020. The diagnosis was made by ultrasound or contrast magnetic resonance imaging. We evaluated the onset symptoms, complications, therapeutic methods, and risk factors. Results: A total of 63 children, mean age 5.14 ± 4.90 (33 boys, 52.38%), were evaluated for EHPVT during the study period. The first symptoms were upper gastrointestinal bleeding (31 children, 49.21%) and splenomegaly (22 children, 34.92%). Thrombocytopenia was present in 44 children (69.84%). The most frequent risk factors were umbilical vein catheterization (46 children, 73.02%) and bacterial infections during the neonatal period (30 children, 47.62%). Protein C, protein S, antithrombin III levels were decreased in 44 of the 48 patients tested. In 42 of these cases, mutations for thrombophilia were tested, and 37 were positive. Upper digestive endoscopy was performed in all cases, revealing esophageal varices in 56 children (88.89%). All children with gastrointestinal bleeding received an octreotide infusion. In 26 children (41.27%), variceal ligation was performed, and in 5 children (7.94%), sclerotherapy. Porto-systemic shunt was performed in 11 children (17.46%), and Meso-Rex shunt was done in 4 children (6.35%). The evolution was favorable in 62 cases (98.41%). Only one child died secondary to severe sepsis. Conclusions: EHPVT is frequently diagnosed in the last period in our region due to the increased use of umbilical vein catheterization. Furthermore, genetic predisposition, neonatal bacterial infections, and prematurity certainly play an important role in this condition. A proactive ultrasound assessment of children with risk factors for EHPVT should be encouraged for early diagnosis and treatment.

Surgical, Interventional, and Medical Palliation of Portal Hypertension

2020 ◽  
Vol 86 (11) ◽  
pp. 1467-1472
Author(s):  
Joseph A. Lin ◽  
James M. Gardner ◽  
Kanti. Pallav Kolli ◽  
Allyson C. Cook
Keyword(s):  
Decision Making ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Breaking Bad News ◽  
Breaking Bad ◽  
Risks And Benefits ◽  
Portosystemic Shunts ◽  
Surgical Options ◽  
Key Steps ◽  
Seriously Ill

Seriously ill surgical patients require complex and integrated surgical, interventional, and medical management to balance the risks and benefits that complicate decision-making. Palliative care principles can aid surgeons in these cases. To illustrate this, we describe a scenario of a patient with unresectable hepatocellular carcinoma with portal vein tumor thrombus causing portal hypertension. We discuss options for managing the sequelae of portal hypertension, including varices and ascites. We explore the interventional and surgical options for mitigating or palliating the underlying portal hypertension. Advances in interventional radiological techniques can facilitate the creation of transjugular intrahepatic portosystemic shunts (TIPSs), even with extensive portal vein thrombus. If interventional approaches are not possible, surgical shunts can be considered but carry significant risks that must be weighed against the benefits. To communicate effectively, we outline key steps to breaking bad news. To make shared decisions in challenging cases, we describe how to elicit a patient’s hopes, expectations, concerns, and preferences; how to synthesize goals of care from these stated values; and how to use those goals to guide decision-making.

A young man with bleeding esophageal varices

2018 ◽  
Vol 1 (1) ◽  
pp. 14-16
Author(s):  
Soonthorn Chonprasertsuk
Keyword(s):  
Risk Factors ◽  
Portal Hypertension ◽  
Liver Function ◽  
Physical Examination ◽  
Esophageal Varices ◽  
Noncirrhotic Portal Hypertension ◽  
Liver Histopathology ◽  
Bleeding Esophageal Varices

The noncirrhotic portal hypertension is an uncommon cause of bleeding esophagealvarices. This condition must be suspected in patients with preserved liver function. We reporta 25-year old man with SLE disease who presented with hematemesis. He had no historyor risk factors for an underlying liver condition. A huge splenomegaly was detectedby physical examination. The EGD found three large varices with red wale sign, whereas liverfunction tests were unremarkable. The noncirrhotic portal hypertension was diagnosedand confirmed by liver histopathology. Figure 1 แสดงผลการส่องกล้องทางเดินอาหารส่วนบนพบ F3 varices with red wale sign

Stability of a rat model of prehepatic portal hypertension caused by partial ligation of the portal vein

2009 ◽  
Vol 15 (32) ◽  
pp. 3449
Author(s):  
Zhe Wen ◽  
Jin-Zhe Zhang ◽  
Hui-Min Xia ◽  
Chun-Xiao Yang ◽  
Ya-Jun Chen
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Rat Model

Clinical manifestations of Liver and Renal impairments in asymptomatic, moderate and severe COVID-19 patients of Madinah city of Saudi Arabia: a retrospective analysis (Preprint)

2020 ◽  
Author(s):  
Firdous Beigh ◽  
Nidda Syeed ◽  
Walaa Saeed ◽  
Ziab Alahmadey ◽  
Ibrahim Seedi
Keyword(s):  
Saudi Arabia ◽  
Clinical Status ◽  
Clinical Manifestations ◽  
Normal Liver ◽  
Significant Percentage ◽  
Renal Functions ◽  
Moderate Disease ◽  
Novel Association ◽  
Liver And Kidney ◽  
Kidney Functions

BACKGROUND Coronavirus disease (COVID-19) is a budding infectious disease that has affected various countries globally. OBJECTIVE The aim of this study was to analyze the effect of COVID-19 disease on liver and kidney functions and to determine their association with the severity and mortality of disease METHODS A total of 100 confirmed COVID-19 adult patients from Madinah city of Saudi Arabia hospitalized between April 28, and June 30, 2020 were included,and categorized into asymptomatic,mild to moderate and severely ill patients.We analyzed the clinical status of liver and renal functioning in all of the three groups. RESULTS The majority of patients (51%) were diagnosed with mild to moderate disease, 27% of patients were severely ill and 22% of patients were asymptomatic.The liver and renal functional analysis showed that the severity of the COVID-19 patients were significantly associated with the kidney and renal impairments exhibiting higher levels of ALT, AST, Creatinine, Urea levels (P < 0.05). Furthermore, in this study, a novel association is found between high Na and Cl levels with the severely ill COVID-19 patients. CONCLUSIONS We concluded from the present study that a significant percentage of COVID-19 patients continued to have a normal liver and renal function during the course of their disease. Nevertheless, severely ill COVID-19 patients were more prone to have abnormal liver and renal functions. During the course of treatment, the patients had a gradual normalization of their liver and kidney parameters and subsequently achieved a complete normal liver and renal functions upon discharge with no mortality.

scholarly journals Stent patency and outcome of TIPS through the left versus the right portal branches

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Mohamed S. Alwarraky ◽  
Hasan A. Elzohary ◽  
Mohamed A. Melegy ◽  
Anwar Mohamed
Keyword(s):  
Portal Hypertension ◽  
Clinical Outcome ◽  
Portal Vein ◽  
Variceal Bleeding ◽  
Patency Rate ◽  
Hospital Admissions ◽  
Stent Patency ◽  
Left Branch ◽  
The Right

Abstract Background Our purpose is to compare the stent patency and clinical outcome of trans-jugular intra-hepatic porto-systemic shunt (TIPS) through the left branch portal vein (TIPS-LPV) to the standard TIPS through the right branch (TIPS-RPV). We retrospectively reviewed all patients (n = 54) with refractory portal hypertension who were subjected to TIPS-LPV at our institute (TIPS-LPV) between 2016 and 2018. These patients were matched with 56 control patients treated with the standard TIPS-RPV (TIPS-RPV). The 2 groups were compared regarding the stent patency rate, encephalopathy, and re-interventions for 1 year after the procedure. Results TIPS-LPV group showed 12 months higher patency rate (90.7% compared to 73.2%) (P < 0.005). The number of the encephalopathy attacks in the TIPS-LPV group was significantly lower than that of the TIPS-RPV group at 6 and 12 months of follow-up [P = 0.012 and 0.036, respectively]. Re-bleeding and improvement of ascites were the same in the two groups [P > 0.05]. Patients underwent TIPS-LPV needed less re-interventions and required less hospitalizations than those with TIPS-RPV [P = 0.039 and P = 0.03, respectively]. Conclusion The new TIPS approach is to extend the stent to LPV. This new TIPS-LPV approach showed the same clinical efficiency as the standard TIPS-RPV in treating variceal bleeding and ascites. However, it proved a better stent patency with lower rates of re-interventions, encephalopathy, and hospital admissions than TIPS through the right branch.

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